Lukas Käsmann1, Maximilian Niyazi2,3,4, Oliver Blanck5, Christian Baues6, René Baumann5, Sophie Dobiasch7, Chukwuka Eze2, Daniel Fleischmann2,3,4, Tobias Gauer8, Frank A Giordano9, Yvonne Goy8, Jan Hausmann10, Christoph Henkenberens11, David Kaul12, Lisa Klook6, David Krug13, Matthias Mäurer14, Cédric M Panje15, Johannes Rosenbrock6, Lisa Sautter9, Daniela Schmitt13, Christoph Süß16, Alexander H Thieme12, Maike Trommer-Nestler6, Sonia Ziegler17, Nadja Ebert18,19, Daniel Medenwald20, Christian Ostheimer21,22. 1. Department of Radiation Oncology, University of Lübeck, Lübeck, Germany. 2. Department of Radiation Oncology, LMU Munich, Munich, Germany. 3. German Cancer Consortium (DKTK), partner site Munich, Munich, Germany. 4. German Cancer Research Center (DKFZ), Heidelberg, Germany. 5. Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany. 6. Department of Radiotherapy, University Hospital of Cologne, Cologne, Germany. 7. Department of Radiation Oncology, Technische Universität München, Munich, Germany. 8. Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 9. Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany. 10. Department of Radiation Oncology, University Medical Center Düsseldorf, Düsseldorf, Germany. 11. Department of Radiation and Special Oncology, Hannover Medical School, Hannover, Germany. 12. Department of Radiation Oncology, Charité School of Medicine and University Hospital, Campus Virchow-Klinikum, Berlin, Germany. 13. Department of Radiation Oncology, University Hospital Heidelberg and National Center for Radiation Research in Oncology (NCRO) and Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany. 14. Department of Radiation Oncology, University Medical Center Jena, Jena, Germany. 15. Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland. 16. Department of Radiation Oncology, University Medical Center Regensburg, Regensburg, Germany. 17. Department of Radiation Oncology, University Medical Center Erlangen, Erlangen, Germany. 18. Department of Radiation Oncology, University Medical Center Dresden, Dresden, Germany. 19. OncoRay-National Center for Radiation Research in Oncology, Dresden, Germany. 20. Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany. 21. Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle, Germany. christian.ostheimer@uk-halle.de. 22. Klinik und Poliklinik für Strahlentherapie, Ernst-Grube-Straße 40, 06120, Universitätsklinikum Halle (Saale), Germany. christian.ostheimer@uk-halle.de.
Abstract
PURPOSE: Lung cancer remains the leading cause of cancer-related mortality worldwide. Stage III non-small cell lung cancer (NSCLC) includes heterogeneous presentation of the disease including lymph node involvement and large tumour volumes with infiltration of the mediastinum, heart or spine. In the treatment of stage III NSCLC an interdisciplinary approach including radiotherapy is considered standard of care with acceptable toxicity and improved clinical outcome concerning local control. Furthermore, gross tumour volume (GTV) changes during definitive radiotherapy would allow for adaptive replanning which offers normal tissue sparing and dose escalation. METHODS: A literature review was conducted to describe the predictive value of GTV changes during definitive radiotherapy especially focussing on overall survival. The literature search was conducted in a two-step review process using PubMed®/Medline® with the key words "stage III non-small cell lung cancer" and "radiotherapy" and "tumour volume" and "prognostic factors". RESULTS: After final consideration 17, 14 and 9 studies with a total of 2516, 784 and 639 patients on predictive impact of GTV, GTV changes and its impact on overall survival, respectively, for definitive radiotherapy for stage III NSCLC were included in this review. Initial GTV is an important prognostic factor for overall survival in several studies, but the time of evaluation and the value of histology need to be further investigated. GTV changes during RT differ widely, optimal timing for re-evaluation of GTV and their predictive value for prognosis needs to be clarified. The prognostic value of GTV changes is unclear due to varying study qualities, re-evaluation time and conflicting results. CONCLUSION: The main findings were that the clinical impact of GTV changes during definitive radiotherapy is still unclear due to heterogeneous study designs with varying quality. Several potential confounding variables were found and need to be considered for future studies to evaluate GTV changes during definitive radiotherapy with respect to treatment outcome.
PURPOSE: Lung cancer remains the leading cause of cancer-related mortality worldwide. Stage III non-small cell lung cancer (NSCLC) includes heterogeneous presentation of the disease including lymph node involvement and large tumour volumes with infiltration of the mediastinum, heart or spine. In the treatment of stage III NSCLC an interdisciplinary approach including radiotherapy is considered standard of care with acceptable toxicity and improved clinical outcome concerning local control. Furthermore, gross tumour volume (GTV) changes during definitive radiotherapy would allow for adaptive replanning which offers normal tissue sparing and dose escalation. METHODS: A literature review was conducted to describe the predictive value of GTV changes during definitive radiotherapy especially focussing on overall survival. The literature search was conducted in a two-step review process using PubMed®/Medline® with the key words "stage III non-small cell lung cancer" and "radiotherapy" and "tumour volume" and "prognostic factors". RESULTS: After final consideration 17, 14 and 9 studies with a total of 2516, 784 and 639 patients on predictive impact of GTV, GTV changes and its impact on overall survival, respectively, for definitive radiotherapy for stage III NSCLC were included in this review. Initial GTV is an important prognostic factor for overall survival in several studies, but the time of evaluation and the value of histology need to be further investigated. GTV changes during RT differ widely, optimal timing for re-evaluation of GTV and their predictive value for prognosis needs to be clarified. The prognostic value of GTV changes is unclear due to varying study qualities, re-evaluation time and conflicting results. CONCLUSION: The main findings were that the clinical impact of GTV changes during definitive radiotherapy is still unclear due to heterogeneous study designs with varying quality. Several potential confounding variables were found and need to be considered for future studies to evaluate GTV changes during definitive radiotherapy with respect to treatment outcome.
Entities:
Keywords:
Clinical multicenter trial; Definitive radiotherapy; Literature review; Stage III lung cancer; Tumor volume changes
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